ConclusionsUV radiation, a classified carcinogen, is commonly and specifically marketed to adolescents through high school newspaper advertising. Public health skin cancer prevention policies should include the prohibition of UV tanning advertising to minors.

Figures in this Article

Frequent tanning parlor use by female adolescents mirrors the increasing incidence of skin cancer in young women1 and has prompted the World Health Organization to recommend that persons younger than 18 years should not use indoor UV radiation tanning devices.2 Although regulations restrict youth-targeted advertising of other carcinogens such as tobacco, no regulations limit youth-targeted advertising of indoor UV tanning.3

METHODS

Public high schools within 3 Colorado counties encompassing the Denver metropolitan area were identified from online listings and telephoned (list of schools available in an online eBox). School representatives were asked to supply 3 or more newspapers printed in 2001 or later. Submitted newspapers, either mailed in or picked up by investigators at the high school, were used to create a database. Data collection began October 1, 2004, and ended September 15, 2005 (Figure).

The following terms were defined: tanning advertisement (any business advertisement located within a newspaper that included the word “tanning”) and unlimited tanning (any advertisement offering “unlimited tanning,” “no limit tanning,” or packages without maximums on amount of use during a specified period). Advertisements were also examined for other discounts, UV-free or sunless tanning, and requirements for parental consent or age restrictions. Advertisement densities (the number of advertisements published in a given season divided by the number of newspapers published in the same season) were calculated for seasons. Seasons were defined as winter (December, January, and February); spring (March, April, and May); summer (June, July, and August); and fall (September, October, and November). Additional data recorded in a Microsoft Access (Microsoft Corp, Redmond, Wash) database included advertisement text, size, date, and source newspaper. Data were double-entered by 2 separate individuals and resolved for discrepancies, and descriptive statistics were generated. All collected data were transferred into a Microsoft Access database, and all statistical analyses were conducted using SAS version 9.1 (SAS Institute, Cary, NC) software.

RESULTS

Twenty-three Denver-area public high schools submitted 131 newspaper issues with commercial advertising (Table). Newspapers received were published between 2001 and 2005 and were most commonly published in 2004 (available in an online eFigure). Newspapers received were most commonly published in the months of May and September (n = 19) and least commonly published in the month of July (n = 0). At least 1 issue of newspapers from 11 schools contained UV tanning advertising (Table). Eighteen unique establishments placed the 40 tanning advertisements found. The highest density of advertisements was found in newspapers published during the spring (spring [0.47] advertisements per number of newspapers published vs winter [0.20], summer [0.25], and fall [0.23]), particularly during the month of April (0.58). Up to 3 advertisements were found in a single newspaper, the largest being one-half page (20 × 26 cm) and the smallest, 8 × 10 cm (mean, 11 × 13.5 cm). Tanning salon advertisements commonly promoted unlimited tanning offers (15 of 40) for periods of up to 4 months. Discounts, often requiring student identification or described as “prom specials,” were mentioned in 19 (48%) of 40 advertisements and included 50%-off promotions and monthly unlimited tanning for as little as $19.99.

Thirteen advertisements (33%) featured non-UV tanning treatments. Two advertisements (5%) mentioned parental guidance: parental consent and accompaniment was required for those younger than 16 years at one establishment, and parental consent was required for those younger than 18 years at the other establishment. One advertisement included the restriction that no one 14 years and younger was permitted to tan.

COMMENT

This study documents abundant UV tanning advertising in public high school newspapers in Denver, a metropolitan area without indoor UV tanning youth access restrictions.3 The study has several limitations: (1) results were not derived from a complete or a randomly selected sample of newspapers, and (2) the data set is too limited to present time trend analysis for particular advertisement subgroups. Similar to a previous study of indoor tanning advertisements in 24 San Diego, Calif, commercial newspapers, we also found that “unlimited” tanning packages were common.4

The escalating cost of treating skin cancers5 mandates a public health policy response. Both meta-analysis and case-control data exist, linking UV radiation from tanning beds and sunlamps to melanoma6 and nonmelanoma skin cancers.7 UV-free tanning options, especially the use of spray-on application systems of dihydroxyacetone-containing tanning solutions, offer teenagers and tanning salons an alternative to UV tanning. Interestingly, a recent study suggests that, like smoking, tanning may be addictive.8 The banning of youth-directed advertising of other carcinogens, namely tobacco, provides a model for public policy response. The UV radiation emitted from sunlamps and sun beds is classified as a group 2A carcinogenic agent by the International Agency for Research on Cancer.9 Further advocacy of legislative restrictions on tanning marketing to adolescents should be adopted.

Previous Presentation: This study was presented at the Society of Investigative Dermatology Annual Meeting; May 4-8, 2005; St Louis, Mo.

Accepted for Publication: December 19, 2005.

Author Contributions:Study concept and design: Dellavalle, Francis, and Freeman. Acquisition of data: Freeman, Lundahl, Francis, and Bowland. Analysis and interpretation of data: Freeman and Dellavalle. Drafting of the manuscript: Freeman, Francis, and Dellavalle. Revision of the manuscript for important intellectual content: Freeman and Dellavalle. Statistical analysis: Freeman and Dellavalle. Study supervision: Dellavalle. Dr Dellavalle, as the principal investigator of this study, had complete access to the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding/Support: This study was supported by the Colorado Department of Health and the Environment, Denver; grant K-07CA92550 from the National Cancer Institute, Bethesda, Md (Dr Dellavalle); and the Department of Dermatology, University of Colorado at Denver and Health Sciences Center.

Acknowledgment: We thank Kathryn Johnson, MD, for help with manuscript preparation, David Crockett for assistance with data entry, and Jennifer Myers, MD, for aid with study preparation. We also thank Sara Miller, MPA, and the members of the Colorado Skin Cancer Task Force, Colorado Department of Health and the Environment, for their input.

World Health Organization, International Agency for Research on Cancer, Solar and Ultraviolet Radiation: Summary of Data Reported and Evaluation. 55 Lyon, France International Agency for Research on Cancer1992;IARC Monographs on the Evaluation of Carcinogenic Risks to Humans

World Health Organization, International Agency for Research on Cancer, Solar and Ultraviolet Radiation: Summary of Data Reported and Evaluation. 55 Lyon, France International Agency for Research on Cancer1992;IARC Monographs on the Evaluation of Carcinogenic Risks to Humans

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